CALIFORNIA TUMOR TISSUE REGISTRY FIFTY- SEVENTH SEMI-ANNUAL SLIDE S~IINAR ON TIJMORS OF THE F~IALE GENITAL TRACT MODERATOR: RlCl!AlUJ C, KEMPSON, M, D, ASSOCIATE PROFESSOR OF PATHOLOGY & CO-DIRECTOR OF SURGICAL PATHOLOGY STANFORD UNIVERSITY MEDICAL CEllTER STANFOliD, CALIFORNIA CHAl~lAN : ALBERT HIRST, M, D, PROFESSOR OF PATHOLOGY LOMA LINDA UNIVERSITY MEDICAL CENTER L~.A LINDA, CALIPORNIA SUNDAY, APRIL 21, 1974 9 : 00 A. M. - 5:30 P,M, REGISTRATION: 7:30 A. M. PASADENA HILTON HOTEL PASADENA, CALIFORNIA Please bring your ~rotocol, but do not bring slides or microscopes to t he meeting, CALIFORNIA TUMOR TISSUE REGISTRY ~lELDON K, BULLOCK, M, D, (EXECUTIVE DIRECTOR) ROGER TERRY, ~1. Ii, (CO-EXECUTIVE DIRECTOR) ~Irs, June Kinsman Mrs. Coral Angus Miss G, Wilma Cline Mrs, Helen Yoshiyama ~fr s. Cheryl Konno Miss Peggy Higgins Mrs. Hataie Nakamura SPONSORS: l~BER PATHOLOGISTS AMERICAN CANCER SOCIETY, CALIFORNIA DIVISION CALIFORNIA MEDICAL ASSOCIATION LAC-USC MEDICAL CENlllR REGIONAL STUDY GRaJPS: LOS ANGELES SAN F~ICISCO CEt;TRAL VALLEY OAKLAND WEST LOS ANGELES SOUTH BAY SANTA EARBARA SAN DIEGO INLAND (SAN BERNARDINO) OHIO SEATTLE ORANGE STOCKTON ARGENTINA SACRJIMENTO ILLINOIS We acknowledge with thanks the voluntary help given by JOHN TRAGERMAN, M. D., PATHOLOGIST, LAC-USC MEDICAL CENlllR VIVIAN GILDENHORN, ASSOCIATE PATHOLOGIST, I~TERCOMMUNITY HOSPITAL ROBERT M. SILTON, M. D,, ASSISTANT PATHOLOGIST, CITY OF HOPE tiEDICAL CENTER JOHN N, O'DON~LL, H. D,, RESIDENT IN PATHOLOGY, LAC-USC MEDICAL CEN!ER JOHN R. CMIG, H. D., RESIDENT IN PATHOLOGY, LAC-USC MEDICAL CENTER CHAPLES GOLDSMITH, M, D. , RESIDENT IN PATHOLOGY, LAC-USC ~IEDICAL CEUTER HAROLD AMSBAUGH, MEDICAL STUDENT, LAC-USC MEDICAL GgNTER N~IE-: E, G. APRIL 21, 1974 - CASE NO , l AGE: 47 SEX: Female RACE: Caucasian ACCESSION NO, 13759 CONTRIBUTOR: Shirley Howard, H, D. OUTSIDE NO. S- 2658-64 St, John's Hospital Santa Monica, California TISSUE FROH: Vagina, left Bartholin' s gland CLINICAL ABSTRACT: History: This 47 year old female noted pain in the left side of the vagina in the region of Bartholin' s gland for several months, lfhen she noted a hard nodule, she consulted her physician immediately. She bad a hysterectomy for carcinoma in situ of the cervix three years earlier. She had an abscess involving the right Bartholin 1 s gland at an earlier unkn01~n, date, Physical examination revealed a stony hard 2 em, nodule possibly fixed to the dee·per tissues in the region of the left Bartholin 1 s gland. There was no obvious involvement of vaginal mucosa or of skin. The regional lymph lymph nodes were not palpable, Radiograph: Cheat film ~1as negative, SURGERY: (June '17, 1964) Excision biopsy was performed, followed by a radical bilateral vulvectomy on June 19, 1964 , GROSS PATHOLOGY: The excision biopsy was a circumscribed, tan, very firm nodule, measuring 1,3 em , in diameter, The nodule bulged from the cut. .aurface of the left Bartholin's gland ~1hich was enlarged and measured 3 x 2.5 x 2 em , The vulvectomy specimen shOI<ed no malignant tumor at the biopsy site, none in the opposite Bartholin's gland, .and no tumor in the inguinal, femoral or in iliac lymph nodes, FOLLOW-UP: (George Hummer, 11, D,) The patient was last seen and examined by her attending surgeon in August 1973 at which tiL1e a vaginal Papanicolaou smear was negative. The patient complained of occasional lower extremity edema that was controlled by the use of support type stockings. There was no evidence of malignant disease, Nfll.JE: L, N, APRIL 21, 1974 - CASE NO, 2 ·AGE: 64 SEX: Female RACE: Caucasian ACCESSION NO, 19905 CONTRIBUTOR: Stuart A, Monroe, M, D, OUTSIDE NO, S72- 7932 St, John's Hospital Tulsa, Oklahoma TISSUE FROM: Uterus CLINICAL ABSTRACT: History: This postmenopausal female presented with a three week history of light to heavy intermittent vaginal spotting. There was no contributory pastmedical or surgical history, Routine laboratory work was normal. A dilation and curettage revealed chunky, firm tissue fragments in association with a uterus which appeared to be "doubled" in size, SURGERY: (September 27, 1972) The uterus was distorted with a profile characteristic of uterine fibroids, A hysterectomy and bilateral salpingo-oophorectomy was accomplished with ease, GROSS PATHOLOGY: The specimen was a 340 gram uterus with attached adnexa. The uterine serosa ~1as unremarkable, The myometrium had several nodular leiomyom!ltous areas ~lith hemorrhage, necrosis, and "mucoid softening", The largest nodule was 8,0 em, in greatest dimension. A prominent submucosal necrotic nodule (2,5 em, in diameter) extended into the uterine cavity, The endometrium was otherwise unremarkable. The fallopian .tubes and ovaries Here normal. FOU.OW·UP: Patient was re-admitted on February 19, 1974 with recurrent pelvic mass and was scheduled for exploratory laparotomy (February 22, 1974). NAME: L, ~1 . APRIL 21, 1974 - CASE NO, 3 AGE: 60 SEX: Female RACE: Negro .J'ICCESSION NO, 955 9 CONTRIBUTOR: Ethel R, Nelson, ~1 . D. OUTSIDE NO. 57-3355 White Memorial Hospital Los Angeles, California TISSUE FRet!: Cervix CLINICAL ABSTRACT: This 60 year old Negro female presented 'dth h~o episodes of vaginal bleeding. Thirty years previously she underwent a bilateral salpingo­ oophorectomy as treatment for pelvic inflammatory disease. She never received any hormone replacement therapy. SURGERY : (August 2, 1957) A total hysterectomy was performed, GROSS PATHOLOGY : The uterus measured 7,2 x 5. 0 x 3,0 em, The endometrium measured 0. 1 em. in thickness and was slightly hemorrhagic. A 2.0 em. tumor , covered by intact mucosa, was present in the posterior lip of the cervix. The mass was light yellow with translucent areas and had the consistency of hard rubber. FOLLOI~ -UP: Thirteen months after surgery, a local recurrence developed in the vaginal cuff and was excised. The patient was then lost to follow up, NAME: L. z. APRIL 21, 1974 - CASE NO. 4 AGE: 12 SEX: Female RACE; FilLgino ACCESSION NO, 20440 CONTRIBUTOR: M, L, Bassis, M, D, OUTSIDE NO. SF 73-2151 Kaiser-Permanente Medical Center San Francisco, California TISSUE FRON : Right ovary .cLINICAL ABSTRACT: History: This 12 year old Filipino girl t~as in good health until one 1~eek prior to admission when slie noticed her abdomen ~1as getting larger and harder, She had not started menstruating and had no axillary hair. On physical examination there was a large hard fixed mass extending from the pelvis to the umbilicus, I Radiograph: An intravenous pyelogram shoWed a right hydronephrosis and hydroureter secondary to extrinsic pressure by a pelvic mass which also caused lateral displacment of the right ureter, A bone series t~as negative, SURGERY: (Febru~ry 20, 1973) A large right ovarian mass Has found, A total abdominal hysterectomy and bilateral salpingo- oophorectomy was performed, GROSS PATHOLOGY: The right ovary measured 18 x 16 x 10 em, and we.ighed 1500 grams , The mottled red-gray to yellm~ surface had bulging cysts containing clear watery yellcw fluid with an apparent intact capsule. The cut surface of the tumor disclosed a variegated pattern with multiple yellm·l lobules inter­ spersed with gray to red-bro~m necrotic zones admixed 1'1ith the cysts which measured up to 6 em, in diameter, The cysts contained watery or viscid yellow fluid and in some instances hemolyzed blood, The fallopian tubes, opposite ovary, and uterus sh~1ed no remarkable features, FOLLOW-UP: This patient received postoperative cobalt-60 radiation delivering 5,020 rads in 51 days which t~as well tolet:ated. She was asymptomatic and free of evident dis·ease until September 1973 when abdominal pain recurred, In early October, left lower quadrant masses and liver enlargement associated ~11th ascites were discovered, Chemotherapy with oral Cytoxan, IV vincristine, actinomycin D and mithramycin was started with rapid response. Five weeks after treatment began no masses were palpable abdominally or on pelvic eKamination, She remained ~Tell through mid-February 1974, She t<as hospitalized with serious deterioration of her condition including gastro­ intestinal bleeding, suspected cardiac involvement(? pericardia! metastasis), ascites, and pelvic tumor recurrence, She died on March 8, 1974. Page 2 APRIL 21, 1974 - CASE NO. 4 ACCESSION NO. 20440 At autopsy there was 3. 5 liters of ascites and tumor covering the peritoneum. The tumor grew in tan grape-like clusters on the serosa. The cut surface was soft whitish tan and homogenous, A single adhesion was seen kinking the si~oid colon. Lymph nodes shewed two microscopic tumor· emboli, No abdominal organs bad intraparettchymal t\llllor except for mild degree of direct extension into the right lobe of the liver. There were no distant metastases. Superficial ~tress ulcer of the gastric fundus were seen, ~IE: I, C, APRIL 21, 1974 • CASE NO , 5 AGE: 57 SEX: Female RACE: Caucasian ACCESSION NO , 13317 CONTRIBUTOR: Daniel Krag, M, D, OUTSID!!: NO, R63- 32 Los Gatos Community Hospital Los Gatos, California TIS SUB FRQol: Cervix CLINICAL ABSTRACT: History: This 57 year old t~hite housewife, t~hose last normal menstrual period ~~as age 45, complained of watery vaginal discharge and intermittent spotting of blood for an unl<nown length of time . On physical examination, she was a robust- appearing woman, The pelvLc organs could not be easily palpated because of vaginal strictur~ but a polypoid lesion presented at the cervix, On December 15, 1962, cervical conization snd uterine curettement were done at another hospital, SURGERY: On Janpary 8, 1963 an abdominal hysterectomy and bilateral salpingo• oophorectomy was performed, GROSS PATHOLOGY: The uterus was 10 x 5 x 6 em. The corpus was nodular and irregularly enlarged by several intramural fibroids, The entire cervical region was enlarged and thickened by an infiltrating pinkish yellow s ticky tumor that surrounded the endocervical canal, The cervical tumor measured 4,5 x 3.2 x 3.0 em, and extended to the margins of excision in the cervical region.